March 28, 2018 (Rivard Report) -- Photographs and awards line the walls and shelves in Colleen Bridger’s office at the San Antonio Metropolitan Health District, mementos from her last job, in Orange County, North Carolina.

“[Before,] a big day for me would be one press conference and two meetings,” Bridger said of her job in Orange County, which has a population of just 135,000. When she took over as San Antonio’s Metro Health Director just over one year ago, she knew she would have to adjust to a much faster pace.

Bridger moved fast and aimed high during her first big push for change, successfully spearheading San Antonio’s effort to become the first city in Texas to raise the age for purchasing tobacco products from 18 to 21. She introduced the idea to City Council in November 2017, and it was passed just three months later.

She called the legislation, known as Tobacco 21, the “most significant public health policy that I will ever be involved with.”

Counterparts from the Big Cities Health Coalition, which comprises leaders of America’s largest metropolitan health departments, called the policy success “remarkable” given that little progress implementing Tobacco 21 has been made in other Texas cities despite overwhelming evidence of the positive health impact.